Safety and efficacy of very short flow diverters for the treatment of intracranial internal carotid artery aneurysms

Deploying flow diverters (FDs) around the carotid siphon typically favors longer FDs for easier manipulation and safety, leaving shorter FDs less explored. We reviewed 263 patients with unruptured intracranial saccular ICA aneurysms treated with FDs from 2013 to 2023. Fifty-five were treated with very short flow diverters (VSFD; 10-12 mm). The primary outcome was complete aneurysm occlusion at 6 months and 1 year, assessed by the Raymond-Roy classification. Secondary outcomes included functional status and retreatment. Complete occlusion rates were 58.2% at 6 months and 70.4% at 1 year in the VSFD group, comparable to the 14-50 mm FD group before and after propensity score matching (PSM). One-year functional outcomes and overall complication rates were similar between groups. The VSFD group had a significantly lower retreatment rate at 4.3% compared to 17.4% in the 14-50 mm FD group (OR 0.21, 95% CI 0.05-0.90, P = 0.04) after PSM. In conclusion, real-world data validate the theoretical concept that VSFDs ensure full deployment and optimal pore density at the aneurysm neck, evidenced by high rates of complete aneurysm occlusion and reduced retreatment rates in our study.